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BASIC INFORMATION: Name: _________________________________________________________________________________ Mailing Address: _______________________________________________________________________ City: _____________________________ State: _____________ Zip: __________________________ Home Phone: ________________________________ Work Phone: ____________________________ FAX: ________________________________________ Email: __________________________________ Sponsor: ________________________________________________________________________________ How did you learn about the 1MR? _______________________________________________________ SPECIAL INTERESTS: Military History- Social History- Handcrafts Other special interests (please specify): _______________________________________________________ EMERGENCY INFORMATION: Emergency Contact Name: ___________________________________________________________________ Emergency Contact Phone: ___________________________________________________________________ Insurance Carrier: ____________________________________ Policy Number: _____________________ Health Problems (of which we should be aware): ______________________________________________ Medications: ________________________________________________________________________________ The consumption of alcoholic beverages, in moderation, is allowed in camp after hours when the public is not present. Lewd and unacceptable behavior will not be tolerated. THE USE OF ANY ILLEGAL DRUG OR NARCOTIC IS FORBIDDEN AT ALL TIMES. ANYONE CAUGHT DOING SO WILL BE EXPELLED FROM THE 1MR IMMEDIATELY. While the 1MR stresses safety at all times, reenacting has the potential to be dangerous. By signing this application, the recruit acknowledges the 1MR will not be liable for injury or damages resulting from his/her participation in this hobby. The applicant further acknowledges his/her willingness to comply with 1MR policy and standards. Signed: ______________________________________________ Date: ______________________________ Contact the Recruiter if you are interested.
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| ©2002 B. White |